Recaps are, obviously, spoiler-filled—but seriously, if you have ever been tempted to just peek before watching, this is not the week to do so. Speaking from personal experience, having looked up the episode to find its original U.K. air date and stumbling across what happened in it, it has never been more important to stay spoiler-free than it is this week. But if you’re not planning to watch or just want to remember, get out your hankie and keep going…

We start out with some very excellent news: baby Branson is on his/her way! Lord Grantham, who is weirdly squeamish about the whole thing, has hired Sir Philip Tapsell, a famous obstetrician, to come consult, and family physician Dr. Clarkson will be present too to make sure everything is ship-shape. It’s good news downstairs for James, who is given the prestigious job of winding the clocks. It’s good news for Ethel the ex-maid, since Isobel Crawley wants to hire her to assist Mrs. Bird, so that she’ll have a non-prostitute job reference. Good news for Edith, because the editor of The Sketch wants her to write a weekly column about modern womanhood. Good news for the Bates’ too, since they can finally see each other and Mr. Bates can tell Anna that she missed a clue in her talk with Vera Bates’ friend Mrs. Bartlett: Mrs. Bartlett said that, the night of Vera’s death, there was pastry under Vera’s nails. The poison that killed Vera was in poisoned pie pastry…so that means she didn’t make the pie until after Mr. Bates was on his way back to Downton. Which means she made the poison pie for herself! Which means she meant to frame her ex-husband! Free Bates!!! (This is particularly good news for anyone watching who might have started to question the goodness of the once-awesome-now-scary Bates.)

But there are signs that not all is as well as it seems.

First, Lord Grantham reminds Cora that Dr. Clarkson was wrong about Matthew’s paralysis and didn’t keep Lavinia Swire from dying of the Spanish Flu, so it will be a crowded delivery room. Then, downstairs, the new kitchen maid Ivy—still on Daisy’s enemies list—suggests that it would be a better idea to have a baby in a city, near a real hospital.

It turns out James doesn’t know how to wind a clock, so he has to follow Mrs. O’Brien’s advice to ask Thomas how, which allows Thomas time to get very close to the handsome younger footman. Then, Mr. Bates’ cellmate Craig and the evil warden have noticed that Bates is in a good mood, and they plan to fix that. Lord Grantham, meanwhile, thinks that The Sketch only wants Edith for her title. Then, Mrs. Bird quits because she refuses to work with a prostitute, leaving Ethel—who can’t even make tea correctly, much less real food—serving Isobel Crawley a failed kidney soufflé. (It also leads to a great exchange of backhanded compliments: “Nobody could look at you and think that [you’re also a prostitute], Mrs. Bird,” says Mrs. Crawley.) Daisy is sad because both James and Alfred are flirting with Ivy.

And that’s only the beginning of the bad news.

Sir Philip Tapsell shows up and is super smarmy, but he says he’s confident that the birth will be a smooth one (and reassures Matthew that a spinal injury shouldn’t affect his fertility, while he’s at it). Dr. Clarkson, on the other hand, is concerned that Lady Sybil’s ankles are swollen. She’s disoriented and the baby seems small to him. Sir Philip says that’s normal. Robert thinks they’re just fighting over professional pride, but the rest of the family thinks they should listen to Clarkson, who sees a danger of eclampsia. Sir Philip bullies Clarkson into silence.

Tom and Sybil chat between contractions, and he tells her he thinks that after the baby comes they should move to Liverpool, where his brother has a garage, but Sybil doesn’t want him to go back to working with cars—and that they should just relax and look at the stars. But they’re inside. Sir Philip says the disorientation is still normal, but…blurgh. Dr. Clarkson barges in and demands to test for toxemia. Sybil now thinks she’s back at the convalescent home, as a nurse. Sir Philip is still sure that eclampsia is not possible, but Dr. Clarkson wants to bring her to the hospital immediately and deliver the baby by c-section, which Sir Philip says is too dangerous. Robert says Sir Philip must be obeyed, because at least he says he’s sure, while Dr. Clarkson talks in possibilities.

And he’s right! It is good news! It’s a girl! They’re both fine! Way to mess with us, Downton. Tom and Sybil hold their new baby, until Sybil goes to sleep, exhausted. She tells Cora, just before bed, that Tom shouldn’t work in a garage even if Robert thinks that would be a good idea, but Cora promises they’ll talk about it tomorrow.

But…not so much. The messing-with-us was just preparation for the messing-with-us to come. Sybil wakes in delirium. Her head hurts, she’s screaming, she goes into a seizure. Dr. Clarkson was right all along. It’s eclampsia. There is nothing to be done. It’s too late. With the whole family in the room, Tom and Cora weeping at her bedside, Lady Sybil dies. “This can’t be,” Robert says—and don’t we wish he were right. And then someone else cries, in another room: the baby.

And in a whole different room…me.

Oh.

My.

God.

If you’re crying too, you’re not alone. Daisy is overcome. Thomas insists he doesn’t care, but then admits to Anna that Lady Sybil was one of the only people in his life who was ever kind of him. Carson remembers that he knew her for her whole life. Cora sits with the body, promising to look after Tom and the baby. In the morning, Mary and Edith, dressed in black, say goodbye to their sister, acknowledging that Sybil was the nice one, that they love each other but only Sybil could make them treat each other well. Cora is clearly in the anger stage of grief: she blames Robert for ignoring Dr. Clarkson.

Mr. Murray, the lawyer, comes to ask Anna about Mrs. Bartlett, and meanwhile Matthew asks him about the estate—Murray has long thought it was being mismanaged—which Mary thinks is highly inappropriate at a time like this. (And even Bates has bad news coming his way: Craig has gotten to Mrs. Bartlett before Murray—so it will be harder to get her statement than expected.)

The last shot of the episode is Tom holding the baby, alone.

Dowager Zinger of the Week: N/A. This is no time for zingers.

History Lesson of the Week: Not everything has changed a great deal in the last hundred years, including some medical knowledge. Eclampsia, what killed Sybil, is the medical term for pregnancy-related seizures. According to the U.S. National Library of Medicine, we still don’t know what causes it. Even today, the main way to treat eclampsia is by delivering the baby as soon as possible; doctors will monitor for preeclampsia (which can be found via blood-pressure and urine tests and used to be called toxemia, the condition Dr. Clarkson fears) and sometimes induce early labor or perform a c-section in order to prevent the condition from progressing to eclampsia. Eclampsia is not always fatal today, but it is still a danger.

I watched a doctor on #AfterAbbey talk about eclampsia, and the state of medical knowledge at that time. It was quite informative. Apparently there were drugs to treat it at the time, and midwives and many doctors would routinely take them to births. (Of course, nothing then or now is 100% effective, but it was better to administer it at the first signs then to wait and see, because it can quickly become too late) A doctor that routinely practiced outside of hospitals and attended aristocratic women at home might be less familiar with this complication and less likely to be prepared. One of the themes of the show is the many ways that women were affected by the paternalistic system, and Lady Sybil's life and death illustrate so many of the difficulties.

My wife had Pre-Eclampsia twice. Each with her last two pregnancies. The last one she was in the Hospital for over three weeks until her blood pressure came down enough to release her. When she first checked in three different nurses and two attendants took her bp and then the rails went up on her bed, and tongue depressors were taped to the wall above her head. Our son was delivered by emergency C-Section about a week later after it was discovered that he was in very little amniotic fluid and as a result going into distress.

It is a miracle that either of them are still with me. Diane and I were both a bit shook up by last nights very realistic episode. Watching Sybil die was most upsetting knowing that could have happened to us but thank God, it did not.

@DerrickParker Im glad that your wife/son made it through sir. It's one of the very few conditions that can result in very bad consequences for a woman if left undetected. Fortunately, medicine has advanced enough to at least treat in advance this debilitating condition. My hat tips to you sir for sharing your story. Not many men could have done that, and you did it very well...